Laboratory Analysis of Antiphospholipid Antibodies with Clinical Correlation: A Hospital-Based 10 Year Study

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S104-S105
Author(s):  
M Myrzykowski ◽  
C Xie ◽  
R Sweet ◽  
M Xie
Keyword(s):  
Antiphospholipid Antibodies ◽  
Beaumont Hospital ◽  
Autoimmune Disorders ◽  
Laboratory Analysis ◽  
Laboratory Evaluation ◽  
Clinical Correlation ◽  
Vascular Thrombosis ◽  
Female Patients ◽  
Clinical Conditions ◽  
Positive Results

Abstract Introduction/Objective Antiphospholipid syndrome (APS) is an autoimmune disorder and its diagnosis requires both laboratory evaluation of antiphospholipid antibodies (APAs) and clinical correlation. This study focused on the laboratory analysis of APS with clinical correlation in a hospital-based patient population. Methods/Case Report From 2010-2020, immunological studies for APAs were performed at Department of Pathology, William Beaumont Hospital – Troy, Michigan and patients with positive results were selected for further analysis. Four APAs were included: IgG and IgM beta-2 glycoprotein I antibodies (IgG B2GA and IgM B2GA), and IgG and IgM anticardiolipin antibodies (IgG ACA and IgM ACA). Clinical information was collected from hospital electronic medical chart with focus on thromboembolism and abortion history, autoimmune disorders, antithrombotic therapies and other studies. Results (if a Case Study enter NA) There were 167 patients, 136 females and 31 males (F/M=4.4). The median age for females was 50 and for males, 57. Overall, B2GA was present more than ACA (102/81) in females, and ACA was present slightly more than B2GA (20/17) in males. IgM APAs were much more common than IgG APAs; IgM B2GA/IgG B2GA: 87/32 (p<0.01) and IgM ACA/IgG ACA: 81/20 (p<0.01). Most APAs were at the low-intermediate titer range and increased APAs titer correlated with decreased positive rate: APAs titer at 20-40, 41-80 and >80 with positive results at 115, 61 and 44 respectively. In addition to documented autoimmune disorders, pregnancy miscarriage was a common clinical condition (24/66) in females at age <45. But for females at age >45, vascular thrombosis became more common (18/70). Vascular thrombosis was a common clinical disease in males (16/31) followed by autoimmune disorders (10/31). Most patients with vascular thrombosis received antithrombotic therapies. Conclusion Female patients positive for APAs was significantly more and younger than males in this study. IgM B2GA was the most common type of APAs followed by IgM ACA. IgG B2GA and IgG ACA were much less common. In younger female patients autoimmune disorders and abortion were the most common clinical conditions. In older female and male patients, autoimmune disorders and vascular thrombosis were the most common clinical conditions. The titer of APAs detected was at low-intermediate range in most patients. The relationship between the titer of APAs and clinical conditions needs further study.

scholarly journals Clinical course of euthyroid subjects with positive TSH receptor antibody: how often does Graves’ disease develop?

2021 ◽  
Author(s):  
Nami Suzuki ◽  
Akiko Kawaguchi ◽  
Jaeduk Yoshimura Noh ◽  
Ran Yoshimura ◽  
Kentaro Mikura ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Clinical Course ◽  
Tsh Receptor ◽  
Graves Disease ◽  
Normal Thyroid ◽  
Receptor Antibody ◽  
Female Patients ◽  
Tsh Receptor Antibody ◽  
Normal Thyroid Function ◽  
Positive Results

Abstract Background Thyroid stimulating hormone (TSH) receptor antibody (TRAb) is detected in the serum of patients with Graves’ disease (GD). This study aims to investigate the prevalence of euthyroid individuals showing positive results for TRAb and to clarify the clinical course of thyroid function and TRAb levels in these subjects. Objective Subjects were female patients who newly visited our hospital for a screening test prior to fertility treatment and showed normal thyroid function and volume without nodules between 2014 and 2017. After excluding subjects with a history of thyroid disease, 5,622 subjects were analyzed. Results Forty-seven of the 5,622 subjects showed positive results for TRAb (reference range, < 2.0 IU/L) at the initial visit. Median initial TRAb was 2.9 IU/L (range, 2.0 -14.7 IU/L) and median follow-up was 18.3 months (range, 0- 66.5 months). Six of the 47 subjects (12.8%) developed GD and median duration until development was 6.6 months (range, 1.2 -13.2 months). Median TRAb values initially and at diagnosisof GD for those 6 patients were 3.7 IU/L (range, 2.7 -5.1 IU/L) and 7.2 IU/L (range 3.6 -21.4 IU/L), respectively. TRAb results turned negative for 20 of the 47 subjects, but remained positive despite normal thyroid function in 13 of the 47 subjects. Conclusion GD developed over time in 12.8% of euthyroid young female patients showing positive TRAb within a median of 6.6 months. A positive result for TRAb itself did not mean development of GD, so other factors must be essential for the pathogenesis of GD.

scholarly journals Autoimmune myelofibrosis: a rare haematological involvement in systemic lupus erythematosus

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227520 ◽  
Author(s):  
Nabil Belfeki ◽  
Gopinath Shankarasivam ◽  
Damienne Declerck ◽  
Sylvain Diamantis
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Bone Marrow ◽  
Clinical Features ◽  
Bone Marrow Biopsy ◽  
Vitamin K ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Vitamin K Antagonists ◽  
Autoimmune Disorders ◽  
Systemic Lupus

Autoimmune myelofibrosis is a distinct clinicopathological entity that occurs with autoimmune disorders. We report the case of a 44-year-old woman admitted with pancytopenia and clinical features of systemic lupus erythematosus, Sjogren’s syndrome and antiphospholipid antibodies syndrome. Bone marrow biopsy showed decreased global cells and an increase of reticulin fibres on argentic coloration, consistent with myelofibrosis. The JAK2 V617, Myeloproliferative leukemia (MPL) and calreticulin mutations were negative. The patient’s condition improved after treatment with hydroxychloroquine, vitamin K antagonists and prednisone.

Autoimmune Antiphospholipid Antibodies Are Directed against a Cryptic Epitope Expressed when β2-Glycoprotein I Is Bound to a Suitable Surface

1995 ◽  
Vol 73 (01) ◽  
pp. 029-034 ◽  
Author(s):  
Vittorio Pengo ◽  
Alessandra Biasiolo ◽  
Maria Grazia Fior
Keyword(s):  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Autoimmune Disorders ◽  
High Antibody ◽  
Anionic Phospholipid ◽  
Glycoprotein I ◽  
Antibody Titres ◽  
Cryptic Epitope ◽  
Antibody Elisa

SummaryThe antiphospholipid antibodies (aPL) present in autoimmune disorders are associated with thromboembolic episodes, and their binding to phospholipids (PL) is mediated by a plasma cofactor, β2-glycoprotein I (β2GPI). Both PL and β2GPI seem necessary for binding, thus indicating that the two components comprise the epitope against which aPL are directed. Using an anti-β2GPI antibody ELISA with the antigen adsorbed onto polyvinylchloride (PVC) plates, we detected high antibody titres in 12 out of 12 plasmas from patients with the antiphospholipid syndrome. No or very low positivity was obtained when the same ELISA was carried out in polystyrene (PST) plates, while an increasing positivity was found when processed (i.e. more hydrophilic) or COOH-surface PST plates were used. When (β2GPI dependent IgG-aPL were purified using agarose-immobilized cardio- lipin, 4 out of 4 preparations were highly positive in anti-β2GPI antibody ELISA using PVC plates, while β2GPI was not fully recognized by aPL-IgG when adsorbed onto PST plates. These findings demonstrate that aPL are, in fact, anti-β2GPI antibodies directed against a cryptic epitope which is expressed when β2GPI is bound to anionic phospholipid, or another suitable surface.

Guidelines for Clinical and Laboratory Evaluation of Patients With Monoclonal Gammopathies

1999 ◽  
Vol 123 (2) ◽  
pp. 106-107 ◽  
Author(s):  
David F. Keren ◽  
Raymond Alexanian ◽  
James A. Goeken ◽  
Peter D. Gorevic ◽  
Robert A. Kyle ◽  
...  
Keyword(s):  
Clinical Condition ◽  
Expert Panel ◽  
Laboratory Evaluation ◽  
Optimal Sequence ◽  
Monoclonal Protein ◽  
Monoclonal Gammopathies ◽  
Laboratory Procedures ◽  
Clinical Conditions

Abstract This guideline provides the recommendations of an expert panel for the clinical and laboratory evaluation of patients suspected of having a clinical condition that produces a monoclonal protein in serum or urine. The recommendations describe the clinical conditions in which a monoclonal protein should be sought, the optimal sequence of testing to diagnose and monitor these patients, and the most effective laboratory procedures.

Antiphospholipid syndrome: critical analysis of the diagnostic path

Lupus ◽  
2010 ◽  
Vol 19 (4) ◽  
pp. 428-431 ◽  
Author(s):  
V. Pengo ◽  
A. Banzato ◽  
E. Bison ◽  
G. Denas ◽  
S. Padayattil Jose ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Critical Analysis ◽  
Single Test ◽  
Single Class ◽  
Vascular Thrombosis ◽  
Pregnancy Morbidity ◽  
Risk Patients ◽  
Pathogenic Antibodies ◽  
Domain I

Antiphospholipid syndrome (APS) is diagnosed in the presence of vascular thrombosis or pregnancy morbidity occurring in patients with circulating antiphospholipid antibodies (lupus anticoagulant [LA] and/or IgG/IgM anticardiolipin [aCL] and/or IgG/IgM anti-β2glycoprotein I [aβ2GPI] antibodies). Each test may identify different autoantibodies; a single test makes the diagnosis possible when positive on two or more occasions at least 12 weeks apart. However, single test positivity may be unrelated to pathogenic antibodies, which are now considered to be a subclass of aβ2GPI antibodies directed against the domain I of this protein. Conversely, all three positive tests identify a single class of aβ2GPI antibodies, thus identifying high-risk patients with APS.

scholarly journals Sources of Bias in Specimens for Research About Molecular Markers for Cancer

2010 ◽  
Vol 28 (4) ◽  
pp. 698-704 ◽  
Author(s):  
David F. Ransohoff ◽  
Margaret L. Gourlay
Keyword(s):  
Systematic Difference ◽  
Laboratory Analysis ◽  
Observational Research ◽  
Central Idea ◽  
Subject Selection ◽  
Prognostic Accuracy ◽  
Positive Results ◽  
Improve Reliability

Claims about the diagnostic or prognostic accuracy of markers often prove disappointing when “discrimination” found between cancers versus normals is due to bias, a systematic difference between compared groups. This article describes a framework to help simplify and organize current problems in marker research by focusing on the role of specimens as a source of bias in observational research and using that focus to address problems and improve reliability. The central idea is that the “fundamental comparison” in research about markers (ie, the comparison done to assess whether a marker discriminates) involves two distinct processes that are “connected” by specimens. If subject selection (first process) creates baseline inequality between groups being compared, then laboratory analysis of specimens (second process) may erroneously find positive results. Although both processes are important, subject selection more fundamentally influences the quality of marker research, because it can hardwire bias into all comparisons in a way that cannot be corrected by any refinement in laboratory analysis. An appreciation of the separateness of these two processes—and placing investigators with appropriate expertise in charge of each—may increase the reliability of research about cancer biomarkers.

Homocysteine and antiphospholipid antibodies in a woman undergoing ovarian follicular stimulation: Prospective clinical and laboratory evaluation

2004 ◽  
Vol 191 (1) ◽  
pp. 370-371 ◽  
Author(s):  
Elvira Grandone ◽  
Gennaro Vecchione ◽  
Donatella Colaizzo ◽  
Filomena Cappucci ◽  
Maurizio Margaglione
Keyword(s):  
Antiphospholipid Antibodies ◽  
Laboratory Evaluation ◽  
Follicular Stimulation

Microparticles: An Alternative Explanation to the Behavior of Vascular Antiphospholipid Syndrome

2021 ◽  
Author(s):  
Daniel Álvarez ◽  
Carolina Rúa ◽  
Ángela P.J. Cadavid
Keyword(s):  
Autoimmune Disease ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Alternative Explanation ◽  
Murine Models ◽  
Vascular Thrombosis ◽  
Pregnancy Morbidity ◽  
Clinical Presentations ◽  
Obstetric Antiphospholipid Syndrome

AbstractAntiphospholipid syndrome is an autoimmune disease characterized by the persistent presence of antiphospholipid antibodies, along with occurrence of vascular thrombosis and pregnancy morbidity. The variety of antiphospholipid antibodies and their related mechanisms, as well as the behavior of disease in wide groups of patients, have led some authors to propose a differentiation of this syndrome into two independent entities: vascular and obstetric antiphospholipid syndrome. Thus, previous studies have discussed whether specific autoantibodies may be responsible for this differentiation or, in contrast, how the same antibodies are able to generate two different clinical presentations. This discussion is yet to be settled. The capability of serum IgG from patients with vascular thrombosis to trigger the biogenesis of endothelial cell-derived microparticles in vitro is one of the previously discussed differences between the clinical entities of antiphospholipid syndrome. These vesicles constitute a prothrombotic mechanism as they can directly lead to clot activation in murine models and recalcified human plasma. Nevertheless, other indirect mechanisms by which microparticles can spread a procoagulant phenotype could be critical to understanding their role in antiphospholipid syndrome. For this reason, questions regarding the cargo of microparticles, and the signaling pathways involved in their biogenesis, are of interest in attempting to explain the behavior of this autoimmune disease.

scholarly journals AB0408 DOES THE PRESENCE IN THE SERUM OF ANTIPHOSPHOLIPID ANTIBODIES CORRELATE WITH SPECIFIC/NON SPECIFIC CAPILLAROSCOPIC ABNORMALITIES?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1504.2-1504
Author(s):  
G. Ferrari ◽  
S. Paolino ◽  
A. Sulli ◽  
C. Pizzorni ◽  
G. Pacini ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Clinical Manifestations ◽  
Statistical Correlation ◽  
Systemic Autoimmune Disease ◽  
Research Support ◽  
Vascular Thrombosis ◽  
Pregnancy Morbidity ◽  
Significant Difference ◽  
Cardiolipin Antibodies

Background:Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by specific vascular and obstetric manifestations and by antiphospholipid antibodies (aPL) positivity [1].To date, little is known regarding nailfold videocapillaroscopy (NVC) alterations in APS patients and in asymptomatic aPL-carriers, non-specific abnormalities being the most frequently reported [2,3,4].Objectives:To retrospectively analyze NVC alterations in APS patients and in asymptomatic aPL-carriers and to correlate NCV alterations with both clinical manifestations and serum aPL profile.Methods:Thirty-five aPL positive patients having received at least one NCV investigation (mean age 47 years, range 16-81, 31 female and 4 male) were retrospectively included in the study. For each patient complete medical history was collected with a particular attention to past vascular thrombosis and pregnancy morbidity. Patients were classified as affected by APS according to the updated Sapporo classification criteria [5]. Lupus anticoagulant (LAC), IgM and IgG anti-cardiolipin antibodies (ACL) and IgM and IgG anti-Beta2 Glycoprotein 1 (anti-B2GP1) were assessed in each patient according to the recommended procedures [5]. NCV parameters were analyzed in each patient, with a particular interest to hemorrhages or nailfold bed-parallel hemosiderin deposits (“comb-like”hemorrhages) presence [2,6]. Statistical analysis was performed by parametric and non-parametric tests.Results:Seventeen patients (mean age 49 years, range 16-81 years) were asymptomatic aPL-carriers and 18 (mean age 46 years, range 26-71 years) were affected by APS. Within APS patients, 16 had a history of vascular thrombosis and 2 had pregnancy morbidity; in 6 patients APS was secondary to other autoimmune rheumatologic conditions (3 to Systemic Lupus Erythematosus, 2 to vasculitides and 1 to Mixed Connective Tissue Disease).Among the total number of aPL-carriers and APS patients six patients showed a normal NVC pattern, 24 patients had non-specific NVC abmormalities and 5 patients had a “scleroderma-like” pattern. Interestingly, NCV microhemorrhages were significantly more frequent in APS patients than in asymptomatic aPL-carriers, both in score and in absolute (p=0.05 andp=0.04, respectively). Particularly, in APS patients “comb-like”hemorrhages had a statistically significant higher prevalence than isolated hemorrhages (p=0.03). Dilated capillaries score was significantly higher in APS patients than in asymptomatic aPL-carriers (p=0.01).Not any statistically significant difference was observed regarding other capillary parameters (score of giant capillaries, loss of capillaries, or anormal shpaes, i.e. angiogenesis). Not any statistical correlation was observed between NVC parameters and different aPL profile.Conclusion:The study shows that the total number of microhemorrhages and in particular the“comb-like”subtype, are significantly the most frequent specific abnormalities in APL patients when compared to asymptomatic aPL carriers. The presence of the “scleroderma like” NVC pattern may suggest a concomitant overlap syndrome. Not any correlation was found between aPL profile and other NVC parameters. Further studies need to develop a more specific APS NVC pattern for APS patients.References:[1]Tektonidou MG, et al RMD Open 2019; 5(1);[2]Cutolo M, Elsevier 2010, pp141-143;[3]Candela M, et al.1998:444-9;[4]Aslanidis S, et al. Clin Exp Rheumatol 2011, 29:307-9;[5]Miyakis S, et al. J Thromb Haemost 2006, 4:295–306;[6]Cutolo M, et al Best Pract Res Clin Rheumatol 2008, 22:1093-108Disclosure of Interests: :Giorgia Ferrari: None declared, Sabrina Paolino: None declared, Alberto Sulli Grant/research support from: Laboratori Baldacci, Carmen Pizzorni: None declared, Greta Pacini: None declared, Emanuele Gotelli: None declared, Adriano Lercara: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, Maurizio Cutolo Grant/research support from: Bristol-Myers Squibb, Actelion, Celgene, Consultant of: Bristol-Myers Squibb, Speakers bureau: Sigma-Alpha

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